Provider Demographics
NPI:1053363366
Name:REARDON, MICHAEL S (MD)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:S
Last Name:REARDON
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:7940 SHOAL CREEK BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78757-7589
Mailing Address - Country:US
Mailing Address - Phone:512-494-4000
Mailing Address - Fax:512-494-4024
Practice Address - Street 1:5301 DAVIS LN BLDG A200
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78749-4062
Practice Address - Country:US
Practice Address - Phone:512-494-4000
Practice Address - Fax:512-494-4090
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2025-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL71322084N0402X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0402XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology with Special Qualifications in Child Neurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX160639403Medicaid
TXH83688Medicare UPIN
TX160639403Medicaid